Using Adenosinetriphosphate (ATP) bioluminescence to validate duodenoscope decontamination

Sue Van Der Graaf 1, Tracy Sloane 1, Elizabeth Gillespie 1, Rhonda Stuart 1,2,3

Monash Health, Clayton, VIC, Australia

Monash University, Clayton, Victoria, Australia

National Centre & Antimicrobial Stewardship, Melbourne, Victoria, Australia
Introduction: Reports of outbreaks involving Carbapenemase Resistant Enterobacteriaceae associated with gastrointestinal endoscopy have prompted the need to assess the cleaning process of these frequently used instruments.

Methods: ATP bioluminescence was used to demonstrate cleanliness prior to Endoscopic Retrograde Cholangiopancreatography (ERCP). A comparison was made between ATP testing and microbiological monitoring for 40 duodenoscopes. Samples were taken pre-cleaning and pre-procedure. Monash Health also routinely uses endoscopy associated bacteraemia surveillance to determine if any episode of bacteraemia occurs between days 0-7 following endoscopic procedures.

Results: ATP values were low in previously cleaned scopes, and
significantly elevated in scopes following an ERCP procedure. Of the 40 microbiological cultures, there was no growth of pathogenic bacteria. Each test using ATP, with concurrent collection of the microbiological sample, added 5-15 minutes to the preparation procedure for ERCP. The adjuvant of endoscopy-related bacteraemia surveillance identified very few cases of bacteraemia post endoscopy. Upon review, none were found to be associated with reprocessing.

Conclusion: ATP testing of duodendoscopes, prior to ERCP procedures, provided a timely marker of safety and quality. Endoscopy associated bacteraemia surveillance further reinforces the real-time value of this system.

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